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I did a little edit after I wrote the post. Nothing important, but it's worth pointing out her mask fit is pretty good from a leak point of view. She is doing very well, but calming down the machine fluctuations is going to make a big difference.

1) Do you think the "soft" comfort level vs standard would be helpful based on any of this?
2) Would the "For Her" model and it's "for her" algorithm (which we don't have, but may go get) likely be of any benefit?

Thanks!

PS - The large leak (around 2:23am) was when she woke up and was adjusting it, so it was completely off for a bit.

I don't see how the For Her is going to make much difference here. She has a lot of snores and flow limitations being recorded at all pressures, and that is driving the machine changes. While the For Her may increase and decrease pressure more slowly, it would still end up at the high end of the range. What we need to figure out is what is necessary, and what is not from a pressure point of view.

The addition of EPR may let a few obstructive apnea through, but it should help a lot with hypopnea, flow limitation and RERA. Her equipment is a very good selection, and I don't think it's worth doing battle with the supplier to change it. Really to have AHI under 2, and the leaks under control as shown on that last chart is a pretty big accomplishment. We're just trying to make it feel better now.

Are the leaks on her cheeks a buzzing leak (aka Face Farts) or a nearly silent stream of air? The buzzing one might get picked up as snores and cause unneeded pressure increases. Though with her flow limitations that seems less likely.

Washing her face and avoiding any lotions before bed will help to reduce leaks. When I wake up at night, I wash my face again as I have oily skin.

Full-face masks are hard to fit as there is more perimeter to leak. I have four, and they are very much not all the same. So far I have only gotten the Simplus to seal well. It can take a lot of fussy, very small adjustments to the straps to get it right. I usually do this when I am in bed, get frustrated, and go back to the Simplus.

Well she spent the entire night pegged against the maximum pressure setting, and showed a pretty steady snore and flow limit. There were mainly hypopnea events that I had hoped would be less with the EPR. Without the cluster at 06:45-07:10 it looks about equal to the previous night. Did she comment if this was more or less comfortable?

The minimum pressure didn't change anything, but limiting the maximum pressure appears to let a lot of events in. The leak line remains very good, but there is a lot of obstruction showing up in the breathing charts. Without the stuff on the left panel I can't compare respiratory rate and volume. It appears using EPR allows her airway to obstruct. That is really the biggest thing we changed, so whether you should keep it, depends on whether she found it better or worse. Another option is to stick with it, and see if this is an adjustment issue.

(01-01-2017, 10:08 AM)Sleeprider Wrote: Well she spent the entire night pegged against the maximum pressure setting, and showed a pretty steady snore and flow limit. There were mainly hypopnea events that I had hoped would be less with the EPR. Without the cluster at 06:45-07:10 it looks about equal to the previous night. Did she comment if this was more or less comfortable?

The minimum pressure didn't change anything, but limiting the maximum pressure appears to let a lot of events in. The leak line remains very good, but there is a lot of obstruction showing up in the breathing charts. Without the stuff on the left panel I can't compare respiratory rate and volume. It appears using EPR allows her airway to obstruct. That is really the biggest thing we changed, so whether you should keep it, depends on whether she found it better or worse. Another option is to stick with it, and see if this is an adjustment issue.

Did your wife have a titration study?

Actually I'm not sure what she had. She had an in-home study to first determine if she needed therapy. No idea if that included any titration, although I'm guessing not.

When I posted, I posted the left panel as a separate image. Just scroll down and it's there.

The mask leaks just made her miserable. We were up late - not sure how much that had to do with it (although no alcohol). She didn't feel like she slept really deep at all.

The night before, there were no leaks measured, last night was almost constant at 3.6. Is it possible that pressure difference dropping out could be some of the problem as well?

I don't understand how it can fit so well one night and be like this the next. But if we can find a mask she can use, I think it will make all the difference in the world. She has 2 weeks of "trial" left where she can switch masks, then has to make her choice. That overall kind of sucks. She's concerned and says "there's only so many masks".

Really had high hopes for a positive difference when she got her machine last month, but she's so discouraged. So please keep the help coming...

Don, the leak rate is so constant, I'd just look for a new option. It is like a low-level leak all night, but no doubt if that is a real leak it is going to be irritating. I think it's worth trying the EPR a while longer and see how that pans out.

Since she had a sleep study and no titraton, I think a discussion is in order with the doctor. If we set the maximum pressure to 20, she will use all of it. These pressures are often treated by bilevel machines, and might be worth investigating with a specialist (ENT) to see if there are structural issues contributing to obstruction. Maybe some of our high-pressure members can offer some insights on how they handle pressure around 20.

I think she had a better night's sleep overall, surprisingly. But also said she remembers waking up gasping at one point. It really wanted to go over 17 at a couple of points and that first batch is crazy - 8 OA in 8 minutes and I don't understand how you can have an obstructive event and a hypopnea at essentially the same time.

It looks to me like we need to boost the high pressure - I think I'm going to try 19. Any suggestions??

On the subject of the mask itself - skin irritation on the bridge of the nose. *sigh*

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